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General NPI Number Information
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NPI Number | 1649559642
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Entity Type | Organization
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Legal Business Name | SIXTEENTH STREET COMMUNITY HEALTH CENTERS, INC.
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 730 W WASHINGTON ST
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City | MILWAUKEE
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State | WI
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Zip | 53204-2310
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Country | US
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Telephone | 414-672-1353
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Fax | 262-408-5094
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Provider Business Mailing Address
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Address Line | PO BOX 778789
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City | CHICAGO
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State | IL
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Zip | 60677-8789
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Country | US
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Telephone | 414-672-1353
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Fax | 262-408-5094
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Authorized Official
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Title or Position | CFO
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Name | MARIA CECILIA S TAYLOR
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Credential |
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Telephone | 414-803-6395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 1507-800
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License Number State | WI
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